Block 2 Unit 3- Multisystem Disorders Flashcards
What is the definition of shock?
the circulatory system fails to adequately perfuse tissues, cells, and organs - resulting in impaired cellular metabolism and tissue function.
What happens to the body if shock is left untreated?
Untreated shock can overwhelm the body’s compensatory mechanisms, resulting in organ dysfunction that may progress to multisystem organ failure.
Inadequate perfusion this leads to ___ ______
cell hypoxia.
Hypoxia leads to an energy deficit resulting in a build-up of ______ ____ because the hypoxia doesn’t allow for _______ metabolism.
lactic acid
aerobic
When lactic acid accumulates during anaerobic metabolism this causes a fall in pH leading to what?
metabolic acidosis.
Metabolic acidosis then causes vasoconstriction, causing failure of the pre-capillary sphincters which results in what?
pooling of the blood peripherally.
If metabolic acidosis is left untreated, this leads to cell membrane dysfunction, releasing digestive enzymes which causes what?
potassium to be excreted and sodium/water retention.
Toxic substances are unable to be metabolized so they remain in the blood stream, damaging capillaries which ends what?
in cell death
What is the most common form of Hypovolemic Shock?
Inadequate fluid volume in the intravascular space is the most common form of shock.
What are the clinical presentation of Hypovolemic Shock?
• Tachycardia
• Hypotension
• Tented, dry skin
• Dry mucous membranes
• Pallor
• Cool skin
• Oliguria
• Low preload/CVP/CO
You have a patient who is presenting to the ED for vomiting and diarrhea. During your initial assessment you noticed the patient has tachycardia, hypotension, low preload and cardiac output, tented dry cool skin, pallor. What would be your suspected Dx?
Hypovolemic Shock
What is the treatment for Hypovolemic Shock?
• The treatment for this type of shock is to treat the underlying cause.
• If they are bleeding, give them blood and stop the bleeding (Tranexamic acid (TXA)
or surgery).
• If it is from a burn or GI loss, they will need additional fluid replacement.
• The addition of vasopressors may be indicated as well.
What are the three types of distributive or circulatory shock?
• Neurogenic
• Septic
• Anaphylactic
Distributive shock is primarily a problem with what?
Distributive shock is primarily a problem with the vasculature.
What is Neurogenic Shock?
A widespread and massive vasodilation that results from an imbalance between the sympathetic and parasympathetic stimulation of vascular smooth muscle.
Does blood volume change during neurogenic shock?
The blood volume has not changed but because of the vasodilation, the pressure has changed.
The decrease in pressure leads to decreased cardiac output, which means decreased oxygen and nutrients to the cells, resulting in cell death.
What are the Sx of neurogenic shock?
• Bradycardia is the most obvious manifestation in the early stages.
• Ejection fraction remains high, but the central venous pressure will decrease as the
vasculature dilates.
• Dizziness and fainting are caused by hypotension and lack of oxygen to the brain.
• Hypothermia occurs due to the vasodilation.
What is the Tx for neurogenic shock?
• Treat underlying cause
• Cautious IV fluids resuscitation for the hypotension because the causative factors are
not volume related and could result in fluid overload.
• Vasopressors will cause vasoconstriction.
• Atropine can be used to increase the heart rate.
• Warming measures to address the hypothermia.
What causes septic shock?
Bacteremia
What is septic shock?
A life-threatening condition caused by a severe localized or system- wide infection.
What is the Tx for septic shock?
• Fluid resuscitation (standard 30ml per kg)
• Antibiotics (broad spectrum)
• Vasopressor medications (to maintain adequate perfusion)
What is the first stage of septic shock?
Infection, A pathogen invades the body and overwhelms the hosts’ defense mechanisms.
What is the second stage of septic shock?
Bacteremia, The infection enters the hosts’ blood stream.
What is the third stage of septic shock?
Organ dysfunction, Abnormal organ function, with or without direct damage to the organ is caused by hypo perfusion.
What is the forth stage of septic shock?
Septic, Sepsis is expressed by life threatening organ dysfunction caused by a dysregulated host response to infection.
Common organs are respiratory, hematologic, cardiac, renal, and hepatic.
What is the fifth stage of septic shock?
Septic shock, The infection has caused organ failure and severe hypotension requiring vasopressors.
You have a patient who’s presenting with tachycardia, hypotension, dyspnea, edema of the tongue, wheezing, pruritus, erythema, anxiety and decreased CO. What is happening to this patient?
They are going through anaphylactic shock
Sepsis is a leading cause of death, morbidity, and expense, contributing to ______________ of deaths of hospitalized patients.
one-third to half
What is the Tx for anaphylactic shock?
• Treatment includes removing the allergen.
• A cocktail of an antihistamine, epinephrine, and a steroid.
• Reptile venom treatment does not use steroids and antihistamines as pretreatment.
• Volume replacement is used to counteract the vasodilation.
• Vasopressors
• Respiratory support
Reptile venom treatment does use steroids and antihistamines as pretreatment. T or F?
False, Reptile venom treatment does not use steroids and antihistamines as pretreatment.
What is happening during Cardiogenic Shock?
This is a problem in which the heart does not generate adequate cardiac output to move the blood throughout the circulatory system. There is no substantial blood loss and no obstruction.
Just a pump problem.
Is a MI a direct of indirect cause of cardiogenic shock?
Indirect
What would be the clinical presentation of cardiogenic shock?
• Chest pain
• Hypotension
• Tachycardia
• Reduced cardiac output
• SOB
• Dysrhythmias
• Elevated troponin levels
• Skin is pale, cool and moist
• Tachypnea
• Increased SVR
Cardiogenic shock treatment focuses on what?
reducing the damage from lack of oxygen to the heart muscle and other organs.
Inotropic agents improve what function of the heart?
Inotropic agents improve the pumping function of the heart
What is a Ventricular assist device (VAD)?
a mechanical device inserted into the right or left ventricle of the heart to help it pump.
A VAD might extend and improve the lives of some people with end-stage heart failure who are waiting for new hearts or aren’t able to have a heart transplant. T or F?
True
Obstructive Shock is caused by what?
Obstructive shock is caused by a physical obstruction in the flow of blood.
The key with shock is knowing the cause/type so that you can do what?
treat early before it progresses to an advanced stage.
What are the 3 stages of shock?
• Compensated
• Progressive
• Refractory
What Is compensated shock?
Compensated shock is when the blood volume is low, but the body is still able to maintain a blood pressure that is adequate to perfuse organs.
What happens to the body during compensated shock?
by increasing the heart rate and vasoconstriction.
• Symptoms include weak pulses, altered mental status, nausea, pallor and clammy skin.
What is uncompensated shock?
At this point the body is unable to maintain adequate blood pressure and perfusion of vital organs (heart, lungs, and brain) is no longer maintained.
What happens to the body during uncompensated shock?
Decreased cardiac output leads to altered capillary permeability. leads to anasarca and pulmonary edema.
Symptoms include systolic blood pressure less than 90, low urine output, hypothermia.
What is refractory shock?
Persistent hypotension with end-organ dysfunction despite fluid resuscitation, vasopressors, oxygenation and ventilation.
During compensatory stage, will the patient is already be showing abnormal signs and symptoms?
Yes
What is Multi Organ Dysfunction Syndrome (MODS)?
A progressive disease often involving the ultimate failure of two or more organ systems after a severe illness or injury; disease process is initiated and perpetuated by uncontrolled systemic inflammatory and stress responses.
During MODS, a stress response is initiated and ______________ are released producing the systemic ________ release.
catecholamines, Cytokine
CPGs are vital to managing all patients injured in a deployed setting and should be referenced for patient care. T or F?
True
What is the first step in managing burns?
determine the extent of the total burn surface area (TBSA) in the form of a percentage.
The front of the head equals _% in the rule of nines
4.5%
The back of the L leg equals _% in the rule of nines
9%
The front and back of each arm and hand equal _% in the rules of nines
9%
CPG guidelines state indications for endotracheal intubation include a comatose patient, symptomatic inhalation injury, deep facial burns, and burns over what % of TBSA?
40%
when caring for a burn casualty in deployed setting, who do you contact?
contact the U.S. Army Institute of Surgical Research (ISR) Burn Center as soon as possible.
If the TBSA is 20% or greater, patients require what?
fluid resuscitation for the next 24 to 48 hours.
Fluid infusion rates are adjusted based on UOP. What is our hourly UOP goal?
Hourly UOP goal is 30-50mL.
For patients weighing more than 80 kg
add ___ mL/hr to IV fluid rate for each
__ kg >__ kg
100mL, 10 kg >80 kg
Use the Rule of Tens to determine fluid requirements for the first 24 hours post-burn. What are the formula to calculate the desired amount?
10 x % TBSA > 40 kg and < 80 kg
if > 80 kg, add 100 ml/hr for every 10kg > 80 kg
Unintentional traumatic injuries are the #1 cause of death for people aged _-__
1-44
How do we manage a external fracture?
• Pin care-assessing skin for signs and symptoms of infection (redness, drainage, etc.)
• Gently clean pin sites per local policy (usually with NS)
• Supporting the limb with turn, the fixator should not be used as a handle.
• Ensure the fixator does not bounce against other objects (bed rails, SMEED, etc.) during transport.
What complications can happen with an external fixator?
• Compartment syndrome
• Osteomyelitis
• Failure of pin or loosening
• Malunion or non-union
• Neurovascular injury
• Refracture around the pin
